Non-Pharmacological Alternatives to Proton Pump Inhibitors: Comparative Clinical Effectiveness and Guidelines - Cadth
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS Non-Pharmacological Alternatives to Proton Pump Inhibitors: Comparative Clinical Effectiveness and Guidelines Service Line: Rapid Response Service Version: 1.0 Publication Date: May 11, 2018 Report Length: 8 Pages
Authors: Michelle Clark, Melissa Severn
Cite As: Non-Pharmacological Alternatives to Proton Pump Inhibitors: Comparative Clinical Effectiveness and Guidelines . Ottawa: CADTH;2018 May .
(CADTH rapid response report: summary of abstracts).
Acknowledgments:
Disclaimer: The inf ormation in this document is intended to help Canadian health care decision-makers, health care prof essionals, health sy stems leaders,
and policy -makers make well-inf ormed decisions and thereby improv e the quality of health care serv ices . While patients and others may access this document,
the document is made av ailable f or inf ormational purposes only and no representations or warranties are made with respect to its f itness f or any particular
purpose. The inf ormation in this document should not be used as a substitute f or prof essional medical adv ice or as a substitute f or the application of clinical
judgment in respect of the care of a particular patient or other prof essional judgment in any decision-making process. The Canadian Agency f or Drugs and
Technologies in Health (CADTH) does not endorse any inf ormation, drugs, therapies, treatments, products, processes, or serv ic es.
While care has been taken to ensure that the inf ormation prepared by CADTH in this document is accurate, complete, a nd up-to-date as at the applicable date
the material was f irst published by CADTH, CADTH does not make any guarantees to that ef f ect. CADTH does not guarantee and is not responsible f or the
quality , currency , propriety , accuracy, or reasonableness of any s tatements, information, or conclusions contained in any third-party materials used in preparing
this document. The v iews and opinions of third parties published in this document do not necessarily state or ref lect those o f CADTH.
CADTH is not responsible f or any errors, omissions, injury , loss, or damage arising f rom or relating to the use (or misuse) of any inf ormation, stateme nts, or
conclusions contained in or implied by the contents of this document or any of the source materials.
This document may contain links to third-party websites. CADTH does not hav e control ov er the content of such sites. Use of third-party sites is gov erned by
the third-party website owners’ own terms and conditions set out f or such sites. CADTH does not make any guarantee with r espect to any inf ormation
contained on such third-party sites and CADTH is not responsible f or any injury , loss, or damage suf f ered as a result of using such third -party sites. CADTH
has no responsibility f or the collection, use, and disclosure of personal inf ormation by third-party sites.
Subject to the af orementioned limitations, the v iews expressed herein are those of CADTH and do not necessarily represent the v iews of Canada’s f ederal,
prov incial, or territorial gov ernments or any third party supplier of inf ormation.
This document is prepared and intended f or use in the context of the Canadian health care sy stem. The use of this document ou tside of Canada is done so at
the user’s own risk.
This disclaimer and any questions or matters of any nature arising f rom or relating to the content or use (or misuse) of this document will be gov erned by and
interpreted in accordance with the laws of the Prov ince of Ontario and the laws of Canada applicable therein, and all proceed ings shall be subject to the
exclusiv e jurisdiction of the courts of the Prov ince of Ontario, Canada.
The copy right and other intellectual property rights in this document are owned by CADTH and its licensors. These rights are protected by the Canadian
Copyright Act and other national and international laws and agreements. Users are permitted to make copies of this document f or non-commercial purposes
only , prov ided it is not modif ied when reproduced and appropriate credit is giv en to CADTH and its licensors.
About CADTH: CADTH is an independent, not-f or-prof it organization responsible f or prov iding Canada’s health care decision-makers with objectiv e ev idence
to help make inf ormed decisions about the optimal use of drugs, medical dev ices, diagnostics, and procedures in our health ca re sy stem.
Funding: CADTH receiv es f unding f rom Canada’s f ederal, prov incial, and territorial gov ernments, with the exception of Quebec.
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 2Research Questions
1. What is the comparative clinical effectiveness of non-pharmacological or alternative
interventions compared to proton pump inhibitors for patients with disorders of
excessive acid secretion?
2. What are the evidence-based guidelines for non-pharmacological or alternative
interventions for patient with excessive acid secretion?
Key Findings
One non-randomized study and three evidence-based guidelines were identified regarding
the comparative clinical effectiveness of non-pharmacological or alternative interventions
compared to proton pump inhibitors for patients with disorders of excessive acid secretion.
Methods
A limited literature search was conducted on key resources including PubMed, The
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases, Canadian and major international health technology agencies, a s well as a
focused Internet search. No filters were applied to limit the retrieval by study type. The
search was also limited to English language documents published between Jan 1, 2013
and Apr 30, 2018. Internet links were provided, where available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria
presented in Table 1.
Table 1: Selection Criteria
Population Patients with disorders of excessive acid secretion (e.g., acid reflux, gastroesophageal reflux disease)
Interventions Non-drug alternatives to proton pump inhibitors (PPIs) (i.e., lifestyle changes – e.g., avoidance of acidic
foods, avoiding lying down after eating, avoiding tight fitting clothes, stopping smoking, elevation of the
head and neck, eating smaller meals and chewing more thoroughly, losing weight)
Comparators Q1: PPIs
Q2: No comparator
Outcomes Q1: Clinical effectiveness (e.g., change in symptoms), safety (e.g., adverse events)
Q2: Evidence based guidelines
Study Designs Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non-
randomized studies, evidence-based guidelines
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 3Results
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta -analyses
are presented first. These are followed by randomized controlled trials, non -randomized
studies, and evidence-based guidelines.
One non-randomized study and three evidence-based guidelines were identified regarding
the comparative clinical effectiveness of non-pharmacological or alternative interventions
compared to proton pump inhibitors for patients with disorders of excessive acid secretion
and guidelines for management. No relevant health technology assessments, systematic
reviews, or randomized controlled trials were identified.
Additional references of potential interest are provided in the appendix.
Overall Summary of Findings
One non-randomized study1 compared the consumption of alkaline water and a mostly
plant-based Mediterranean diet with standard reflux precautions with the use of proton
pump inhibitors (PPIs) and standard reflux precautions for the management of
laryngopharyngeal reflux. A greater percentage of patients in the diet group achieved a
clinically meaningful reduction in the Reflux Symptoms Index, but the difference was not
statistically significant. Despite the lack of a significant difference in outcome s between
groups, the authors suggested that the dietary approach should be considered as an option
for the treatment of reflux because of the lower cost and lack of adverse events when
compared with PPIs.1
A guideline from the University of Michigan 2 recommends that patients be prescribed
lifestyle interventions for the treatment of gastroesophageal reflux disease (GERD)
including: smoking cessation, avoiding specific foods, avoiding large meals, and avoiding
certain medications, but specifies that only the recommendations for weight los s and
avoiding lying flat after meals are based on evidence-based data.2 A guideline for the
management of GERD and dyspepsia in adults from the National Institute for Health and
Care Excellence 3 recommends advice related to healthy eating, weight loss, an d smoking
cessation should be provided to all patients seeking treatment for GERD. The American
College of Gastroenterology4 recommends a number of lifestyle interventions for the
management of GERD including weight loss for patients who are overweight, el evation of
the head of the bed, and avoiding meals two to three hours before bedtime.
References Summarized
Health Technology Assessments
No literature identified.
Systematic Reviews and Meta-analyses
No literature identified.
Randomized Controlled Trials
No literature identified.
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 4Non-Randomized Studies
1. Zalvan CH, Hu S, Greenberg B, Geliebter J. A Comparison of Alkaline Water and
Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal
Reflux. JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1023-9. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710251
PubMed: PM28880991
Guidelines and Recommendations
2. Gastroesophageal reflux disease (GERD) [Internet]. Ann Arbor (MI): Regents of the
University of Michigan; 2013 Sep. [cited 2018 May 11; content reviewd 2018 Mar].
Available from: https://www.med.umich.edu/1info/FHP/practiceguides/gerd/gerd.12.pdf
3. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and
management [Internet]. London: The National Institute for Health and Care Excellence;
2014 Nov. [cited 2018 May 11]. (Clinical guideline [CG184]). Available from:
https://www.nice.org.uk/guidance/cg184
See: 1.2.1, page 10
4. Katz PO, Gerson LB, Vela MF. Diagnosis and management of gastroesophageal reflux
disease. Am J Gastroenterol [Internet]. 2013 [cited 2018 May 11];108:308 -28. Available
from: https://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-
disease/
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 5Appendix — Further Information
Previous CADTH Reports
5. Proton Pump Inhibitors for Gastrointestinal Conditions: A Review of Clinical
Effectiveness and Cost-Effectiveness [Internet]. Ottawa: CADTH; 2015 Jun 19. [cited
2018 May 11]. (Rapid response summary with critical appraisal). Available from:
https://www.cadth.ca/proton-pump-inhibitors-gastrointestinal-conditions-review-clinical-
effectiveness-and-cost
6. Proton Pump Inhibitors Cessation Programs: A Review of Clinical Effectiveness, Cost-
effectiveness and Guidelines [Internet]. Ottawa: CADTH; 2014 Oct 2. [cited 2018 May
11]. (Rapid response summary with critical appraisal). Available from:
https://www.cadth.ca/proton-pump-inhibitors-cessation-programs-review-clinical-
effectiveness-cost-effectiveness-and
Systematic Reviews and Meta-Analyses – No Comparison to PPIs
7. Casale M, Sabatino L, Moffa A, Capuano F, Luccarelli V, Vitali M, et al. Breathing
training on lower esophageal sphincter as a complementary treatment of
gastroesophageal reflux disease (GERD): a systematic review. Eur Rev Med Pharmacol
Sci. 2016 Nov;20(21):4547-52.
PubMed: PM27874942
8. Kang JH, Kang JY. Lifestyle measures in the management of gastro -oesophageal reflux
disease: clinical and pathophysiological considerations. Ther Adv Chronic Dis. 2015
Mar;6(2):51-64. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331235
PubMed: 25729556
Non-Randomized Studies
Lifestyle Interventions in Combination with Pharmaceutical Interventions
9. Ong AM, Chua LT, Khor CJ, Asokkumar R, Namasivayam O, Wang YT. Diaphragmatic
Breathing Reduces Belching and Proton Pump Inhibitor Refractory Gastroesophageal
Reflux Symptoms. Clin Gastroenterol Hepatol. 2018 Mar;16(3):407-16.
PubMed: PM29104130
10. Allampati S, Lopez R, Thota PN, Ray M, Birgisson S, Gabbard SL. Use of a positional
therapy device significantly improves nocturnal gastroesophageal reflux symptoms. Dis
Esophagus. 2017 Feb 1;30(3):1-7.
PubMed: PM27629558
11. Haruma K, Kinoshita Y, Sakamoto S, Sanada K, Hiroi S, Miwa H. Lifestyle factors and
efficacy of lifestyle interventions in gastroesophageal reflux disease patients with
functional dyspepsia: primary care perspectives from the LEGEND study. Intern Med.
2015;54(7):695-701.
PubMed: PM25832928
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 6Not Compared with PPIs
12. Randhawa MA, Mahfouz SA, Selim NA, Yar T, Gillessen A. An old dietary regimen as a
new lifestyle change for Gastro esophageal reflux disease: A pilot study. Pak J Pharm
Sci. 2015 Sep;28(5):1583-6.
PubMed: PM26408867
Clinical Practice Guidelines – Methodology Not Specified
13. Dagli U, Kalkan IH. The role of lifestyle changes in gastroesophageal reflux diseases
treatment. Turk J Gastroenterol [Internet]. 2017 [cited 2018 May 11];28 (suppl 1):S33-
S37. Available from: http://www.turkjgastroenterol.org/sayilar/303/buyuk/S33-S37.pdf
14. Richardson B. the role of nutrition in preventing and managing GERD. Nutrition &
Foodservice EDGE [Internet]. 2017 [cited 2018 May 11];July - August. Available from:
https://www.anfponline.org/docs/default-source/legacy-docs/docs/ce-
articles/nc072017.pdf
15. Gastroesophageal reflux disease (GERD) [Internet]. Portland (OR): The Portland Clinic;
2013. [cited 2018 May 11]. Available from: http://www.theportlandclinic.com/wp-
content/uploads/2017/01/10560-Gastroesophageal-Reflux-Disease.pdf
Review Articles
16. Chuang TW, Chen SC, Chen KT. Current status of gastroesophageal reflux disease :
diagnosis and treatment. Acta Gastroenterol Belg. 2017 Jul;80(3):396-404.
PubMed: PM29560670
17. Patti MG. An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux
Disease. JAMA Surg. 2016 Jan;151(1):73-8.
PubMed: PM26629969
18. Treating heartburn and gastro-esophageal relflux (GERD) [Internet]. Toronto: Choosing
Wisely Canada; 2014 Oct 29. [cited 2018 May 11]. Available from:
https://choosingwiselycanada.org/wp-content/uploads/2017/05/GERD-EN.pdf
Additional References
19. Kroch DA, Madanick RD. Medical Treatment of Gastroesophageal Reflux Disease.
World J Surg. 2017 Jul;41(7):1678-84.
PubMed: PM28321555
20. Keung C, Hebbard G. The management of gastro-oesophageal reflux disease. Aust
Prescr. 2016 Feb;39(1):6-10. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816873
PubMed: PM27041798
21. Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease.
World J Gastrointest Pharmacol Ther. 2014 Aug 6;5(3):105-12. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133436
PubMed: PM25133039
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 722. Diet and gastroesophageal reflux disease (GERD) [Internet]. Downers Grove (IL):
American Society for Gastrointestinal Endoscopy; 2014. [cited 2018 May 11]. Available
from: https://www.asge.org/docs/default-source/about-asge/newsroom/doc-
gerd_infographic_final.pdf
SUMMARY OF ABSTRACTS Non-Pharmacological Alternativ es to Proton Pump Inhibitors 8You can also read
